Coronavirus: Indonesia in need is the region’s nightmare
Jakarta’s coffin makers have been doing double shifts this week, burials in the city of 10 million people are up 40 per cent, and some doctors are already having to make decisions over which patient gets a ventilator.
Yet Indonesia ended the week with just 3512 confirmed COVID-19 patients and an official death toll of 306 people, a fraction of the health crisis Europe and the US are now facing.
With one of the lowest rates of COVID-19 testing in the world — just 73 per million people — and a government that until its first detected case on March 2 was still trying to market itself as a virus-free tourist destination, it’s not surprising Indonesia’s infection rates are unfeasibly low.
Indonesia’s COVID-19 mortality rate is hovering around 9 per cent, a sign that infection rates are far higher than official figures. The few laboratories capable of processing COVID-19 test swabs are reporting a processing backlog in the thousands.
Australia’s most important neighbour is nowhere near the peak of its COVID-19 pandemic, yet its chronically underfunded health system is already cracking under the strain.
Updated modelling from University of Indonesia researchers suggests Indonesia could now have a million infected patients, and that more than 120,000 people will die by the end of May if the government does not impose a nationwide lockdown and mass swab testing.
University of Indonesia epidemiologist Pandu Riono, part of the team whose modelling has recently shaken the Indonesian government from its torpor, says the country has just 8158 ventilators for a population of almost 270 million people. “Already some doctors in Jakarta I know are having to choose who gets intubated,” Pandu told Inquirer. “We need far more aggressive measures because the hospitals in Indonesia are very limited.”
Indonesia’s neighbours have been watching with rising concern as the government has consistently prioritised the economy ahead of public health, and fumbled preparations for a pandemic that has brought far more robust health systems to their knees.
Now Australia has made the extraordinary decision to withdraw its top envoy, Gary Quinlan, from its largest overseas mission this weekend for fear that, in the current crisis, Indonesia’s health system cannot provide lifesaving assistance if required.
The Department of Foreign Affairs and Trade has stressed the 69-year-old career diplomat, who has underlying health conditions, will continue his role remotely from Canberra and that the embassy, operating on a skeleton staff, will continue to function under his deputy, Allaster Cox.
But the move has underscored deep concern over Indonesia’s ability to navigate the public health crisis. Already one Australian citizen is believed to have died in a Jakarta hospital from COVID-19. Another was lucky to survive after contracting the virus and booking himself into one of Jakarta’s best private hospitals only to witness intensive care unit doctors and nurses with no protective clothing, and untested patients dying of respiratory failure. Indonesia has just two ICU beds for every 100,000 people and four doctors for every 10,000 people. Those doctors are dying at an alarming rate from COVID-19; at least 26 doctors and nine nurses so far because of a shortage of protective clothing.
The embassy’s warnings to expatriates to get out of Indonesia have taken on an increasingly urgent tone.
“Think about your and your family’s health. Critical medical care in Indonesia is significantly below Australian standards,” Quinlan urged in a recent message. “The Australian government cannot guarantee you access to medical services or a safe exit if the situation in Indonesia gets worse. Come back to Australia while you still can.”
Few doubt the potential for a humanitarian catastrophe in Indonesia but there are rising fears the COVID-19 health crisis could also cascade into an economic and security crisis.
“Indonesia is the worst positioned to contain the virus”, London-based analysts TS Lombard warned this month after comparing the readiness of Southeast Asia’s largest economy with Thailand and the Philippines.
“The combination of less rigorous social distancing measures and a weak healthcare service means Indonesia is the least likely of the three countries to stop the spread of the virus anytime soon.”
“It’s got the potential to be a far more dangerous situation than just COVID-19 and I think that’s also at the back of the mind of the Australian government,” says Indonesia Institute president Ross Taylor.
“Apart from losing potentially hundreds of thousands of people, there is also the possibility of social instability because of mass unemployment and people falling back into poverty. If we end up with an absolute catastrophe on our doorstep in Indonesia, what is the Australian policy on that? Are we going to help out like we did after the tsunami and Bali bombing or … do we say ‘sorry guys, you’re on your own’?”
Inquirer understands there has been heightened ministerial engagement between the two governments in recent weeks as Australia recalibrates its existing development programs to help the Indonesian government prepare for the crisis.
An unstable Indonesia is clearly disastrous for Australia. Should its health crisis spill over into a financial one — as the World Bank recently predicted — years of work building up effective partnerships against terrorism, people-smuggling, transnational and cyber crime could be at risk.
“In Asia, Indonesia is the frontline of defence against financial contagion,” a group of Australian National University academics warned in the East Asia Forum blog this week.
“Crises will spread throughout our region unless action is taken to steady financial systems against the rising tide of capital outflow. Southeast Asian countries … need lines of credit and support to stave off deep, long-lasting crises that will reverberate across the whole region.”
Australia provided $1bn in standby credits to Indonesia in 1997 during the Asian financial crisis, then again after the 2004 Boxing Day tsunami. It offered $650m during the 2008 global financial crisis. But in the past five years it has cut aid to Indonesia by half — from $610m a year to $298m in 2019-20 — to help pay for the “Pacific step-up” policy.
University of Melbourne Indonesian law expert Tim Lindsey says the crisis should “remind Australia why Indonesia is so important”.
“Once this is all over Australia needs to look really seriously at its non-existent aid program and make Indonesia’s health and government systems a priority.”
Former Australian ambassador to Indonesia John McCarthy says the government may have to consider additional aid “not just on humanitarian grounds but also on security grounds”.
“It’s a question of government showing leadership and explaining why, even at times of enormous difficulties in Australia, we have certain responsibilities to the region. There is going to be a real need to try and get the Indonesian economy up again and we have to think of the stability arguments,” he told Inquirer.
“There are very strong nationalist and Islamist elements in Indonesia … and if the government was seen to be weak and the country in economic paralysis, those sorts of forces would be in a position to take advantage of that instability.”
Australia’s 1997 loan could not prevent the collapse of the Suharto regime the following year when opposition forces capitalised on the economic crisis to instigate deadly riots in Jakarta targeting the country’s minority ethnic Chinese community.
Now, again, there are signs of rising anti-Chinese sentiment as millions of poor Indonesians find themselves out of work and struggling to put food on the table.
“One theme has been that rich Indonesian Chinese have been fleeing to Singapore to avoid the epidemic,” the Jakarta-based Institute for Policy Analysis of Conflict noted, citing online posts labelling Chinese Indonesians “disgusting losers and traitors”.
IPAC’s Sidney Jones says the potential for local outbreaks of unrest is high, particularly around the Muslim fasting month of Ramadan — starting April 23 — and the subsequent Idul Fitri holiday.
“The thing the government has to be worried about is food riots or mass frustration because of an inability to buy goods, and that’s why they’re being careful to keep announcing that people will get packets and cash,” she told Inquirer.
President Joko Widodo has already announced three social relief packages worth $40bn and is seeking loans and expanded credit lines from agencies including the New York Federal Reserve and the International Monetary Fund.
The government has recently opened a specialist COVID-19 hospital in Jakarta’s Asian Games athletes village, another in a former Vietnamese refugee camp on Galang Island, and just this week begun distributing PCR (polymerase chain reaction) swab tests after an early reliance on rapid antibody tests not designed to diagnose current infections.
On Friday, the Jakarta administration was also finally authorised to enforce lockdown measures put in place last month.
But Widodo is resisting a nationwide lockdown ahead of the mass homecoming (mudik) of more than 20 million people for Idul Fitri, fearing it could incite similar chaos to that in India where a snap lockdown has caused mass suffering for millions of people living hand to mouth. Instead he has offered financial incentives for those who stay put, and warned those who go home must spend two weeks in quarantine.
The policy is causing mass confusion and anxiety, and many communities are taking measures into their own hands. Some have erected plastic barriers at the entry to their villages. Others have prevented bodies from being buried in their cemeteries.
In Indonesia’s overcrowded hospitals, already exhausted doctors and nurses are bracing for an escalation of the outbreak to the remotest corners of the archipelago, where there is little to no capacity to deal with the virus.
“I’m very worried about mudik. Already we are missing many, many cases (because) our facilities aren’t capable of diagnosing them,” one Jakarta public hospital doctor, Andi Khomeini Takdir, told Inquirer.
“There are patients walking into clinics that don’t even have an X-ray machine, and they’re being recorded as suffering from cough and cold.
“If anyone falls sick in Jakarta, at least the hospitals are better equipped to treat them. I just can’t imagine the scenario in villages where the only facility is a community health clinic.”
Additional reporting: Chandni Vasandani